POS0926 HOW GOOD ARE WE AT CAPTURING THE GI SYMPTOMS IN OUR PATIENTS WITH SCLERODERMA?
Authors: R. Parry, C. Rhys Dillon
Journal: Annals of the Rheumatic Diseases (2022)

Background Scleroderma is a rare autoimmune condition affecting around 1 in 10,000 individuals causing multisystem inflammation and fibrosis. The gastrointestinal (GI) system is the most commonly affected system, with nearly 90% of patients experiencing GI manifestations. The disease can affect any part of the GI tract with symptoms ranging in severity. Complications include oesophagitis and oesophageal strictures, vascular lesions in the stomach, reduced movement and absorption within the intestines and anorectal involvement. Recent guidance by the BSR highlight the importance of GI complications. Objectives To conduct a quality improvement project to improve the care provided to our scleroderma patients, focusing on GI symptom burden and identifying any unmet need when comparing local care to BSR guidelines and consensus best practice guidelines. Methods A proforma was developed for assessing and treating GI symptoms based on BSR and consensus best practice guidelines. This proforma was trialled on an initial cohort of 32 scleroderma patients from the Royal Glamorgan Hospital in Wales. The last clinical assessment was assessed for the following - regurgitation, nausea, vomiting, heartburn, dysphagia, abdominal pain, bloating, diarrhoea, faecal incontinence, constipation and weight loss. The symptoms were recorded as present, not present or not documented. The management of symptoms were evaluated against the guidelines. The cohort were then contacted regarding their last clinical assessment and asked if they were experiencing these symptoms at the time of their last assessment. The results from the documented assessment were compared to the additional patient information to address unmet needs. Results The results show that there is limited documentation of the presence of GI symptoms amongst scleroderma patients at clinic appointments. The initial assessment results were compared with the subsequent patient telephone reported symptoms in order to identify unmet need. The following refer to unidentified symptoms at assessment - regurgitation 9%, nausea 6%, vomiting 3%, heartburn 31%, dysphagia 31%, abdominal pain 9%, bloating 25%, diarrhoea 6%, faecal incontinence 9%, constipation 15% and weight loss 19%. Many patients stated they were unaware that their condition could cause GI symptoms and would not routinely mention these symptoms in a rheumatology assessment. The proforma proves to be an effective way to document and guide management of these patients. The clinical proforma that has now been created will help us improve patient care which can be reassessed in the future. Table 1. Symptoms Management Regurgitation 1 case - not investigated due to pre-existing dysmotility Nausea 0 cases Vomiting 0 cases Heartburn 4 cases – 3 on PPIs, 1 gastroscopy arranged Dysphagia 6 cases – 2 of known dysmotility, 3 not investigated Abdominal pain 2 cases – not investigated Bloating 1 case – not investigated Diarrhoea 0 cases Faecal incontinence 1 case – MRI arranged for query small bowel obstruction Constipation 4 cases – 1 longstanding issue, 1 MRI arranged, 2 not investigated Weight loss 1 case – not investigated Conclusion The piloting of our proforma of the GI assessment of patients with scleroderma has identified that the documentation of GI symptoms was poor. We don’t know whether GI symptomology was discussed during assessment however it’s evident that it was not often documented. Patients don’t always report symptoms unless targeted questions are asked. A clinic proforma would be invaluable, leading to an increased awareness amongst both practitioners and patients of the potential clinical manifestations. Having presented this data locally we have now introduced such a proforma and will re-evaluate clinical practice in the future. Sharing this information will hopefully help improve patient care elsewhere. References [1]Hansi N, Thoua N, Carulli M, Chakravarty K, Lal S, Smyth A, et al. Consensus best practice pathway of the UK scleroderma study group: gastrointestinal manifestations of systemic sclerosis. Clin Exp Rheumatol. 2014; 32(6 Suppl 86):S-214-21. Disclosure of Interests None declared